News
Canadian-made blood test for concussions could radically simplify diagnosis
Concussions are notoriously difficult to diagnose and don’t appear on brain scans. At the moment, doctors rely on their own judgement and a patient’s description of their symptoms for diagnosis. However, medical researchers in London, Ont. say they have developed a simple blood test that can detect if someone has suffered a concussion with more than 90% accuracy. The findings, made by scientists from Western University and the Lawson Health Research Institute, were published in the journal Metabolomics. The blood test uses a small sample drawn within 72 hours of a sudden blow to the head and measures 174 brain chemicals that change in response to a brain injury.
The researchers say the test is the most accurate concussion test in the world and could help identify concussed athletes early so they can take time to recover before returning to sports. "The advantages are it takes away the guessing. So right away we would know if somebody has truly had a concussion," said Dr. Douglas Fraser, a clinician and scientist at the Lawson Health Research Institute who led the study. The group is now working to confirm the accuracy of the blood test in more athletes and military personnel. The goal is for the blood test to become a widely-used diagnostic tool within the next five years.
Automated clinical laboratory opens in UAB hospital
Until now, a team of late-shift clinical technologists in the University of Alabama at Birmingham analyzed between 4,000 and 5,000 tubes of blood every night, providing information to help guide patient care, while keeping watch for abnormal test results that require immediate notification to clinicians.
Now a new $6.8 million, automated lab in the Department of Hospital Labs, Division of Laboratory Medicine does the work. While the automated line was being installed and calibrated, the hands-on analysis by laboratory technologists had to continue in other lab spaces. "It’s like redesigning a plane while you are flying it — the technologists and lab techs have been phenomenal employees working in such complex conditions during the renovation this past year," said Sherry Polhill, MBA, the administrative director of UAB Hospital Labs and Respiratory Care. Polhill says the technologists and lab techs are able to make a move to newly established laboratory industry lines within Hospital Laboratories as the automated equipment is coming online.
Read more about the experience of the staff, the changes in their lab processes and the positive patient outcomes associated with automation in the article.
Pre-Analytical
Center for Phlebotomy Education's Tip of the Month
When collecting blood are you using safe practices at all times? Check out the Center for Phlebotomy Education's Countdown to Safety to review some very important safety practices.
A couple of highlights:
- I always wear the personal protective equipment my employer has designated for a given task.
- I make sure a sharps container is available at the point of use and is not overfilled.
- I never position my finger in front of the needle when anchoring a vein.
- I consistently practice hand hygiene.
- I report safety hazards and violations when encountered.
Hematology
Researchers develop potential oral treatment for hemophilia
About 400,000 people worldwide have either hemophilia A or B, both of which are caused by a missing protein in the blood. People with hemophilia have to endure painful injections every few days to stay alive, but a newly developed treatment may offer a simpler, cheaper and less painful alternative in the future.
University of Texas at Austin researchers created an oral treatment for one type of hemophilia. However, the capsule is still in development and further tests are required before clinical trials can be considered. The oral treatment contains nanoparticles that carry a protein therapy for factor IX to treat hemophilia B. The treatment is encapsulated, allowing it to pass through the stomach without being destroyed by gastric enzymes. It isn't until the capsule reaches the small intestine that it begins to swell and degrade. As the capsule degrades, the treatment is slowly released.
"While an oral delivery platform will be beneficial to all hemophilia B patients, patients in developing countries will benefit the most," study lead author Sarena Horava said in a university news release. "In many developing countries, the median life expectancy for hemophilia patients is 11 years due to the lack of access to treatment, but our new oral delivery of factor IX can now overcome these issues and improve the worldwide use of this therapy," Horava said.
Transfusion Medicine
Preventing mortality after myocardial infarction
Quote: "This clinical trial is the logical follow-up to our research on transfusion thresholds going back more than 30 years. It will help us resolve one of the last major issues in the field," says Dr. Jacques Lacroix, an intensivist at Sainte-Justine Hospital, professor at Université de Montréal.
The University of Montreal Hospital Research Centre has been awarded a grant of US$2 million from the National Institutes of Health to pilot the Canadian component of a study to determine the optimal amount of blood to transfuse in anemic patients who have suffered a myocardial infarction. MINT, for Myocardial Ischemia and Transfusion, is a vast randomized clinical trial conducted in more than 70 North American hospitals that will compare two blood transfusion strategies in 3,500 at risk patients. "We are going to determine whether giving more blood to keep the patient at a threshold of 100 g/L hemoglobin is preferable to giving less blood with a threshold of 80 g/L. We will see the impact on mortality after 30 days," says Dr. Paul Hébert, holder of the Héma-Québec - Bayer Chair in Transfusion Medicine at Université de Montréal.
The MINT team will also assess whether the amount of hemoglobin given to cardiac patients affects the risk of complications such as thrombosis or pneumonia. "Our findings will definitely influence practice and ultimately save lives. We can be more effective when an anemic patient suffers a heart attack, and prevent recurrences," Dr. Hébert concludes.
Microbiology
Bacteria responsible for incurable bone infection hide in bone micro-channels
Bacteria that cause life-threatening and incurable bone infections may elude immune or antibiotic attack by hiding in tiny channels within bone, according to researchers at the University of Rochester Medical Center. Researchers in the Center for Musculoskeletal Research conducted the first systematic study to define where and how Staphylococcus aureus hides in bones, yielding the first demonstration that the bacteria can change shape and "move" to colonize tiny channels in mouse bone.
To investigate, the researchers performed systematic transmission electron microscopy (TEM) of S. aureus infected mouse femurs and tibias. It was discovered that the S. aureus squeeze from round to rod-shaped to fit into canaliculi that are many times smaller in diameter than the bacteria, which has never before been documented. Captured images suggest that S. aureus can "move", though not in the traditional sense. Since it lacks the typical appendages of motile bacteria, S. aureus must move by dividing asymmetrically and pushing daughter cells in a desired direction, such as into canaliculi.
"This may explain why surgeons see reinfections, as well as several reports published in medical journals where spontaneous recurrence of infection appears 50-75 years later," said Karen de Mesy Bentley, M.S., director of the Electron Microscopy Shared Laboratory and faculty associate in the Department of Pathology and Laboratory Medicine at the University of Rochester Medical Centre.
Anatomic Pathology
Examining uterine lavage fluid for early signs of endometrial cancer
According to Dr. Peter Dottino, director of Gynecologic Oncology at Mount Sinai Health System his interests are to investigate, "...the possibility of coupling newly developed genomic technologies with current treatment practices to develop a precision medicine assay for screening and early detection of this cancer."
His study, published in PLOS Medicine, collected blood samples and uterine lavage from 107 patients who had hysterectomy and curettage for diagnostic evaluation. The lavage samples—processed to generate cellular and cell-free (cf) DNA—underwent next-generation sequencing using 2 gene panels (56 genes and 12 genes). The hysteroscopy samples were simultaneously analyzed using standard histopathology techniques.
Seven patients were diagnosed with endometrial cancer based on histopathologic analysis, 6 of whom had stage IA cancer; 1 cancer was detectable only as a microscopic focus within a polyp. Genetic analysis found all 7 patients had significant cancer-associated mutations in the cell pellet as well as the cfDNA.
Patients whose tumor samples were not available in sufficient quantities had their lavage samples tested; all tumor mutations above a specific allele fraction were found in the lavage DNA samples, the authors write. Of the remaining 95 patients who had benign or non-cancer pathology, 51 had high allele fraction, cancer-associated mutations, which were not detected by histopathologic analysis. "Given that a uterine lavage can be easily and quickly performed even outside of the operating room and in a physician’s office-based setting, our findings suggest the future possibility of this approach for screening women for the earliest stages of endometrial cancer," the authors concluded.
Research
Swiss researchers use new mass spectrometry technique to obtain protein data, create strategy that could lead to clinical laboratory advances in personalized medicine
Researchers in Switzerland are developing a new way to use mass spectrometry to explain why patients respond differently to specific therapies. The method potentially could become a useful tool for clinical laboratories that want to support the practice of precision medicine.
The groundbreaking systems biology study utilized a new mass spectrometry technique to better understand the role proteins play in metabolizing fat. By connecting the variations in individuals’ genomes to the variations in their proteomes, the Swiss researchers may have overcome a major obstacle to the development of personalized medicine.
Researchers measured a total of 2,600 different proteins from tissue samples of 40 mice strains, all of which were genetically related to each other. The mice were divided into groups representing each of the 40 strains and fed either a high-fat or low-fat diet. Despite their similar genetic make-up, the mice on the high-fat diet responded differently to diet and exercise. Some developed metabolic disorders such as fatty liver, while others on the same diet and exercise routine did not. When the researchers combined the physiological data from the mice with their genome, proteome, and transcriptome data, they were better able to understand the role proteins play when metabolizing fat and producing energy from it. They identified "genomic variants of mitochondrial enzymes that caused inborn errors in metabolism, and revealed two genes that appear to function in cholesterol metabolism," noted the Science research article. "The approach we used in the mouse cohort can now be applied one-for-one in research on human diseases, and particularly for personalized medicine," Dr. Aebersold stated.
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